MCAT, Step 1, and the Physician Shortage: The Critical Role of Trinity

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One of the most common questions our admissions team is asked is, “I’ve heard matching is much harder for IMGs. Is that true?”

Our answer is always the same. “No, it’s not true.”

Sometimes explaining this involves first getting into the complex history of medical education standards, or the outdated view that Caribbean schools lack rigor or quality. CARICOM has gone to great lengths to rectify this with programs like CAAM-HP, and Trinity has always prided itself on the quality of its educaton, but there are still challenges to overcome.

That said, it’s crucial to remember that there are many, many factors that go into the residency match. We’ll attempt to address a few of them in this post.

First, though, we need to speak to the outdated stigma and calm anxieties perpetuated by (understandably) nervous student communities and the uninformed: while the United States and Canada are facing physician shortages, and while this is often attributed to a lack of residency opportunties, that is not entirely accurate.

The demand for physicians outstrips the number of medical students produced by US medical schools, let alone the number of residency slots available (to the tune of about 4,000 extra residencies, with that gap projected to grow an additional 6000 over the next ten years). The residency slots are there; the demand for doctors is high. Being an international medical graduate is simply not the barrier it once was, with the American College of Physicians openly acknowledging not only the value of these students and their passion for medicine, but recognizing that the United States healthcare system actively depends on IMGs to address the medical needs of the 300,000,000 people living within the nation’s borders.

So, why the perception of limited access creating a physician shortage?

It’s more than a perception. There is a choke point, it’s just the match receives too much focus; a significant portion of the issue is in the medical school admissions process itself. It can be addressed, though.

The competition to be admitted to an allopathic US or Canadian medical school is very high, and one of the major factors is MCAT scores. The MCAT, a test designed to measure a student’s ability to perform in medical school, is ostensibly a good thing; it helps schools get through the field of applicants efficiently and creates a barrier for people that may dream of becoming a doctor but just aren’t adequately prepared or suited for it.

Except there is a disparity between its effective value and its application. Don’t get us wrong, it’s an important metric, but it can be over emphasized and therefore too restrictive. As a result, a lot of excellent physicians don’t get the educational opportunity they need to join the field and make a difference.

You don’t have to take our word for it. Dr. Darrell Kirch, president of the AAMC, said it himself, “The MCAT doesn’t predict how good a doctor you’ll be,” he said. “I can point to many very successful medical students when I was a dean who had scores below that, and those [with scores] above that who struggled for various reasons.”

This is why Trinity looks at the entire candidate, and evaluates on a much deeper level. As a smaller school, this is a major advantage for our team and our students (more on that later). We have so many students that showed great potential with MCAT scores that were good, not great, who then went on to not only place near the top in their Step 1 scores and then proved themselves as excellent physicians. Trinity changes the MCAT from a barrier to clear to an indicator of progress: the MCAT score may be where a student’s knowledge began, and it can highlight any strengths and weaknesses early on, but it becomes about how far they’ve come and show their capacity to grow.

The National Residency Match Program (NRMP) surveyed residency program directors across the country about their decision making criteria and determined that the single greatest factor in assessing whether an applicant is considered is their step 1 score. Trinity aggressively prepairs its students for this with its comprehensive Step 1 prep program, as well as its curriculum of early clinical experience designed to cement classroom lessons.

And it works. See the data yourself.

Our students don’t just pass, they are strong performers. Beyond bringing the school itself a great sense of accomplishment at having effectively prepared its students to serve the healthcare needs of the US and Canada in the future, it shows us that the “Trinity Advantage,” (small class size, engaged faculty, community culture, etc.) works. And it doesn’t just apply to step 1. Other critical criteria include step 2 scores (see below), grades in general, grades in clerkships, grades in specialty-relevant clerkship, etc. These factors are all well within our students’ control, as they are with any student.

Trinity’s culture even extends to areas that are typically outside a student’s direct control. The report emphasizes the weight of letters of recommendation in residency. Beyond their close, professional relationships with the faculty, recognized, accomplished medical professionals in their own right, Trinity’s culture of community outreach means the school is affiliated with a number of NGOs that frequently visit the island to perform necessary medical services. Trinity students are granted the opportunity to assist (if they so choose) when these groups visit. This not only results in a higher level educational opportunity from the very best, it creates amazing networking opportunities for the students, which can come in handy when it’s time for that next career step.

As we’ve stated time and again, Trinity is a school where students who have always sought the opportunity to focus, to thrive, find that opportunity.

All that said, I suppose we have a question for you.

It’s 2015. Trinity is an accredited, respected, tested, and proven school with a pedigree of American and Canadian alumni that grows in success and complexity every year. It does good work, and trains doctors to hold on and cherish their natural inclination towards patient contact and helping others.

What are you waiting for, exactly?


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